197起群体伤害事件回顾性分析及院内处置流程探讨

郭朋; 曹帆; 高明强; 申捷; 莫为春

doi:10.16369/j.oher.issn.1007-1326.2024.01.017

197起群体伤害事件回顾性分析及院内处置流程探讨

Retrospective analysis of 197 mass casualty incidents and exploration of hospital management procedures

摘要

摘要:
目的探讨上海市金山区群体伤害事件的特点及院内处置流程，为规范处置群体伤害事件提供临床建议。
方法回顾性分析2010年1月1日—2021年12月31日复旦大学附属金山医院处置的群体伤害事件，分析群体伤害事件的特点及院内救治流程。
结果该医院12年中处置的群体伤害事件共197起，总伤害人数1 430人；首要伤害原因是交通事故100起（占50.9%），其次是化学伤害25起（占12.7%）。伤害人群最多的年龄分布在21~50岁之间，共995人（占69.5%）；男性964人（占67.4%），女性466人（占32.6%）；来院已死亡23人（占1.6%），入住ICU患者73人（占5.1%），入院治疗患者106人（占7.4%）。群体伤害事件在3—5月（春季）为60起（占30.5%）、6—8月（夏季）为52起（占26.4%）、9—11月（秋季）为54起（占27.4%），发生频次相近，12月—次年2月（冬季）频次则有所减少，为31起（占15.7%）。8—16点的发生频次最高，为186起（占94.4%），16—24点为11起（占5.6%），而0—8点无群体伤害事件发生。2016年启用新的救治流程后，预警率明显提高（P < 0.05），预警内容增多（P < 0.01），救治物资调配时间明显缩短（P < 0.01），二次验伤准确率提高（P < 0.01），滞留时间明显减少（P < 0.01）。
结论在上海金山地区，群体伤害事件首要原因是交通事故，其次是化学伤害；群体伤多发年龄段在20~50岁之间；男性明显多于女性。群体伤害事件救治要点包括早期预警、及时启动救治流程、分区分级救治、损伤控制、及时分流、有经验的指挥者、总结与演练。

Abstract:
Objective To understand the characteristics and hospital management procedures of mass casualty incidents in Jinshan District and to provide clinical suggestions for standardizing the management of mass casualty incidents.
Methods A retrospective analysis of mass casualty incidents handled by the Affiliated Jinshan Hospital of Fudan University from January 1, 2010 to December 31, 2021 was conducted, and the characteristics and hospital treatment procedures of mass casualty incidents were analyzed.
Results The hospital handled 197 mass casualty incidents in 12 years, with a total of 1430 injured persons. The primary cause of injury was traffic accidents, accounting for 100 cases(50.9%), followed by chemical injuries, accounting for 25 cases(12.7%). The most common age distribution of the injured population was between 21 and 50 years old, with 995 people(69.5%); 964(67.4%) were male and 466(32.6%) were female; 23(1.6%) were dead on arrival; 73(5.1%) were admitted to the ICU, and 106(7.4%) were hospitalized. The frequency of mass casualty incidents was similar in March to May(spring) with 60 cases(30.5%), June to August(summer) with 52 cases(26.4%), and September to November(autumn) with 54 cases(27.4%), while the frequency decreased in December to next February(winter) with 31 cases(15.7%). The highest frequency of occurrence was from 8:00 to 16:00, with 186cases(94.4%), followed by 16:00 to 24:00, with 11 cases(5.6%), and no mass casualty incidents occurred from 0:00 to 8:00. After the new treatment procedure was implemented in 2016, the forewarning rate increased significantly(P < 0.05), the forewarning content increased(P < 0.01), and the allocation time of treatment materials was significantly shortened(P < 0.01); the accuracy rate of secondary injury assessment increased(P < 0.01), and the retention time was significantly reduced(P < 0.01).
Conclusions In Jinshan District of Shanghai, the primary cause of mass casualty incidents was traffic accidents, followed by chemical injuries. The age group with the most mass casualties was between 20 and 50 years old, with males significantly outnumbering females. The key points of mass casualty incident treatment include forewarning, timely initiation of treatment procedures, zone and hierarchical treatment, secondary damage control, timely diversion, experienced commanders, summary, and drills.

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